Dermoid ovarian cyst: causes, treatment,operation, is it possible to get pregnant

Update: October 2018 Among women diagnosed
ovarian cyst in 20% of cases observed dermoid cyst. This
a cyst is not life threatening in case of
small size, but with the growth it must be removed.
Dermo cyst does not apply to hormone-active tumors,
therefore does not affect the menstrual cycle and childbearing
function. However, from 1 to 3% of cases described education
reborn into ovarian cancer.

The term “dermoid cyst”

Cysts are sacculate formations that are filled
fluid. This fluid is produced by the walls of the cystic capsule.
Ovarian cysts are functional and true. Functional
cysts may disappear on their own or after
conservative treatment, the same cysts are removed only
operative way and are considered benign tumors. If a
the contents (fluid secret) of functional cysts are formed by the walls
their capsules, the contents of true cysts arises by dividing
cell capsules. True ovarian cysts include
endometrioid, cystadenoma (serous and mucinous),
paraovarian cyst of the ovary, and, accordingly, dermoid
cyst.

Description of a dermoid cyst

Other names for dermoid cysts are mature teratoma or
dermoid This type of neoplasm refers to germ cell,
there are germinal tumors and has a round or oval shape.
The walls of the cystic dermoid capsule are thin, but sufficient
durable.

As a rule, dermoids are single-chamber, but there are two and
multi-cysts. The cavity of the mature teratoma is filled with thick
mucus-like fluid in which fatty tissue can meet
(fat), hair and teeth, bones, nerve tissue and sebaceous glands).

The growth of a dermoid cyst is very slow, but influenced by some
factors it can increase and reach 15 cm in diameter. how
usually dermoid cysts are found in one of the ovaries, but
their localization is also possible.

Dermoids can be diagnosed at different age periods, from
newborn to postmenopause. More often mature teratome is found on
right ovary, due to its anatomical features.
The right ovary is much larger than the left, it is better blood supply, and
ovulation occurs more often in it (68%).

Causes and origin of dermoids

To date, reliable causes of dermoid
ovarian cysts are being studied. However, it has been established that in the development
dermoid violations of differentiation of tissues during
prenatal period. It becomes clear that the occurrence
Mature teratomas do not cause hormonal changes, they only
stimulate the growth of education. This is due to the detection
dermoid cysts of considerable size in adolescent girls,
pregnant women and menopausal women when in the body
hormonal changes take place.

Due to the disruption of embryogenesis in the ovary,
stay and survive fragments of germinal tissue, of which in
будущем и вырастет дермоидная cyst. Germ tissues are made up of
three layers:

  • the ectoderm from which skin, intestinal parts develop,
    nervous tissue and sense organs;
  • mesoderm, which gives rise to bone and cartilage tissues,
    muscles, kidneys and blood vessels;
  • endoderm – from it develop intestinal mucosa, liver and
    pancreas, as well as lungs, thyroid and salivary
    glands.

Since the development of this education are layers associated with
dermis, it was called dermoid cyst.

Violation of embryogenesis occurs as a result of
the impact on the future mother of harmful factors:

  • physical radioactive radiation very high or extremely
    low temperatures;
  • chemical exposure – the use of highly toxic drugs,
    drugs, food poisoning and household poisons,
    disturbed ecology);
  • biological – various pathogenic microorganisms, congenital
    anomalies and genetic and chromosomal abnormalities.

Provoking factors

�The following factors can “spur” cyst growth:

  • hormonal surges (periods of gestation, puberty and
    premenopause);
  • stress;
  • chronic pathology of the reproductive system;
  • operations on the pelvic organs;
  • abdominal trauma.

Clinical picture

Dermoid grows very slowly, so there is a clear clinical picture.
for small sizes it does not. how правило, маленькие
neoplasms are detected by chance during
gynecological examination or ultrasound examination of organs
small pelvis. Minor aching recurring pain
appear when teratoma reaches 5 cm.

If a дермоид в диаметре достигает 10 – 15 см, появляются
characteristic signs:

  • pains in the lower abdomen;
  • unclear, migrating pain localization;
  • чувство давления,  распирания и тяжести внизу живота;
  • increased abdominal volume (with significant size, especially in
    lean women);
  • frequent urination due to tumor pressure on
    bladder;
  • possible burning and soreness when urinating;
  • impaired work intestines (constipations are replaced by diarrhea, which also
    due to compression of the lower intestinal regions);
  • painful intercourse (optional).

The cyst of the left ovary is formed much less frequently than the right one, which
due to the anatomical features of the sex glands. Seldom
diagnose bilateral teratomas.

Dermoid on the background of pregnancy

Dermoid ovarian cyst and pregnancy do not exclude each other.
That is, the conception and subsequent development of the fetus is quite possible on
the background of the existing education, as the dermoid does not cause
hormonal changes in the body and does not lead to infertility.
Ovarian neoplasm can quite easily survive the whole
pregnancy without showing itself. But the growth of cyst in
gestational period when significant hormonal
adjustment.

In addition, as the uterus grows, the location changes somewhat.
abdominal organs. The intestine is lifted and squeezed,
the stomach shifts, and the ovaries move from the usual place
stay Therefore, during pregnancy, especially when growing
teratomas increase the chances of complications. Pregnant
the uterus can squeeze the cyst and cause its rupture, change
the location of the ovary can lead to torsion of the cyst legs
or due to increased intra-abdominal pressure and concomitant
Vaginal infection cyst may fester. All listed
complications require immediate surgery despite
на наличие of pregnancy.

Complications

A large dermoid cyst is often complicated by the fact that
requires immediate surgery. To possible
The complications of dermoid include:

Torsion of teratoma

As the tumor grows and thanks to its long leg,
changes its location and can twist around its own
180 axis and even 360 degrees. how правило, это происходит
after considerable physical exertion, but can happen without
visible reasons. Twisting the legs of a dermoid causes a disturbance in it
blood circulation (blood cannot flow through squeezed vessels in
swelling), which leads to a very sharp pain, forcing
the patient must assume a forced position (horizontal, with
legs and knees bent). The pain does not even stop
taking analgesics. Against the background of discontinued circulation in
necrosis of a dermoid gradually develops. Appear
signs of intoxication, and further peritoneal symptoms.
Byвышается  температура (до 39 – 40), исчезает аппетит,
nausea and vomiting join. Muscles of the anterior abdominal wall
are tense, to the stomach is impossible
to touch.

Dermoid rupture

It also provokes hard physical labor. At the time of the break
cysts a woman feels a sharp, dagger pain that can
give in the crotch, in the lumbar region and in the leg. Rupture
the contents of the dermoid irritates the abdominal cavity and the internal
organs that manifest peritoneal symptoms (positive
Shchetkin’s symptom, tension of abdominal muscles). If a оказание медицинской
help is delayed, signs of intoxication appear (increased
temperature, dyspeptic symptoms.

Cyst suppuration

Inflammation of a dermoid cyst may trigger
pathogenic flora in the body. It can be either sharp or
chronic inflammatory processes of the reproductive system
(colpitis, cervicitis, adnexitis and others) and other foci
chronic infection (tonsillitis, caries, pyelonephritis). Infectious
agents enter the dermoid through the blood vessels, which leads to
his suppuration. The patient has signs of intoxication, which
over time only increase, symptoms of irritation appear
peritoneum and significant abdominal pain.

Diagnostics

In the diagnosis of pathology, the following methods are used:

Gynecological examination

Bimanual abdominal palpation
(vaginal-abdominal or recto-abdominal) allows
to palpate the elastic formation of a round or oval shape,
which is located anteriorly and somewhat to the side of the uterus. With
palpation does not feel soreness, and the tumor itself is sufficient
movable.

Pelvic ultrasound

Ultrasound (preferably with transvaginal sensor)
fairly accurately reveals the presence of a dermoid cyst. With
the study establishes the size and localization of teratoma,
the thickness of the capsule (it is thickened in a dermoid), the intensity
blood supply, the presence of contents and inclusions in it,
ECHO density of cystic elements.

MRI and CT

These research methods help to clarify the nature
neoplasms (benign or malignant).

Pregnancy test

With поступлении женщины в стационар с признаками острого живота
pregnancy test is required to exclude
ectopic and abdominal puncture through the posterior fornix, which
allow you to confirm / deny the presence of blood in the abdominal
cavities.

Laparoscopic surgery

It is performed with a diagnostic purpose in case of doubts in the diagnosis.
(usually for emergency reasons), allows not only
identify the cause of acute abdomen, but also eliminate it.

Definition of tumor markers

Blood tests for tumor markers are compulsory (CA-199,
CA-125 and others), which helps to eliminate the malignant nature
education.

Treatment

Treatment дермоидной кисты яичника проводится только хирургическим
in a way. No medication, especially hormonal drugs.
funds will not help get rid of teratoma. Similarly, there is no point.
try to cure the pathology of folk methods, in some cases
(intensive douching, warming and the introduction of vaginal
tampons) it can cause complications.

Preoperative preparation

When назначения плановой операции по поводу кисты яичника
thorough preoperative preparation is carried out, which
includes:

  • Full examination

UAC and OAM, biochemistry and blood sugar are prescribed on an outpatient basis.
determination of the group and rhesus, blood clotting is investigated and
vaginal smears. You also need to donate blood for syphilis,
hepatitis and HIV infection. In the hospital, if necessary, appoint
retesting.

  • Examination by a general practitioner and dentist

Consultation therapist and dentist are appointed at the hospital
stage to identify and correct chronic extragenital
pathology and sanitation of carious teeth. Therapist will prescribe
ECG, and according to FGDS indications, colonoscopy and
sigmoidoscopy.

  • Pelvic ultrasound

Repeats in hospital to establish exact dimensions.
tumors and its localization.

  • Patient consent for surgery

A prerequisite for the operation to remove the dermoid
is to obtain the written consent of the woman. The doctor must
tell about the pathology, the volume of the planned operation, possible
complications and answer questions.

  • Preparation of the gastrointestinal tract

It consists in the appointment of light food for 12 hours before
operations, taking laxative drugs in the evening, on the eve
interventions and cleansing enemas in the morning
operations.

  • Phase of the menstrual cycle

All gynecological organ-saving operations are planning on
first phase of the cycle (reduced risk of bleeding during
operations).

  • Prevention of venous thrombosis

When приема пациенткой КОК необходимо прекратить их
use at least 4 weeks prior to surgery
interventions. On the day of surgery, lower limbs bandage
elastic bandages.

Operative intervention

The tactics of surgical treatment depends on many factors.
The operating gynecologist should consider:

  • age of the patient;
  • the size of education;
  • location of the cyst;
  • neglect of the process (with long existing and large
    formations it is possible the formation of adhesions in the pelvis, which
    complicates the operation);
  • cyst complications (torsion or suppuration, which requires
    conducting an immediate operation);
  • nature of education (benign or
    malignant).

The volume of surgery to remove a dermoid cyst may vary.
Perform the following types of surgery:

Cystectomy

This type of removal operation consists in trapping
(excision) of the cyst, while trying not to violate the integrity of her
capsules, within the healthy tissues of the ovary. Performing a cystectomy
possible with small education, when it is not yet
germinated ovarian tissue and does not violate ovarian function.
Conducted by young women planning a pregnancy.

Wedge resection of the ovary

It consists in excision of not only the education itself, but also parts
gonad (cyst damaged part of the ovary). After resection
ovarian functions are fully restored, including
reproductive (in the remaining organ remains sufficiently
follicles for egg maturation). A similar operation is performed
with a volume of education in 5 – 7 cm and with twisting the legs.

Ovariectomy

It consists in the complete removal of the ovary. In some cases, the volume
operations expand to adnexectomy — removal of the fallopian tube and
половой glands. This surgery is performed
premenopausal and menopausal patients, as well as
with complications (suppuration and necrosis of the cyst, rupture of the formation).

In 90% of cases, laparoscopy of the dermoid cyst is performed. By
Emergency laparotomy is performed (anterior
abdominal wall in a straight line of the abdomen or Pfanneshtil).
Laparoscopic surgery снижает риск операционных и
postoperative complications (bleeding, thrombosis and
thromboembolism), and also reduces the duration of stay in
hospital

Byслеоперационный период

Byсле удаления тератомы в случае лапаротомии пациентке
allowed to get up the next day (after about 24 hours).
If a проводилась лапароскопическая операция, двигаться и
you can get out of bed after 5-6 hours, and the statement
be made on 4 – 5 days. Byсле лапаротомии женщину отпускают
home after 8 – 10 days.

In the postoperative period is carried out medication
therapy:

  • antibacterial (broad spectrum drugs: cephalosporins,
    fluoroquinolones) to prevent postoperative inflammation
    wounds;
  • anti-inflammatory (metronidazole, nonsteroidal
    anti-inflammatory drugs: indomethacin, nise, ibuprofen) – not
    only reduce the risk inflammations, but also relieve pain;
  • vitamins according to the phase of the menstrual cycle for
    rapid recovery of ovarian function;
  • immunomodulators (cycloferon, timogen) – patients with
    weakened immunodeficiency.

Women planning a pregnancy for the next 6 months after
operations are shown taking COC for contraception and recovery
functions of the sex glands.

Question answer

Вопрос: Мне удалили дермоидную кисту месяц назад.
When can I plan a pregnancy?

Pregnancy can be planned no earlier than six months after
surgical treatment. During this time, treat chronic
diseases, undergo additional examinations (hidden genital
infections), redefine lifestyle (avoiding harmful
habits).

Вопрос: howой прогноз после удаления dermoid?

If the operation was carried out in a timely and efficient manner, then
menstrual, sexual and childbearing functions do not suffer, that is
favorable prognosis.

Вопрос: У меня срок беременности 12 недель. On ultrasound
identified a dermoid of small size, about 3 cm. How is it
will affect pregnancy and will not require surgery?

The presence of dermoid cysts does not affect the course
of pregnancy. But the growth of education or the occurrence of
various complications. Conduct a planned operation in the period
gestation is not required, except for the significant size of the cyst,
which in the process of growth of the uterus can twist or burst.
A planned operation in this case is performed after the 16th week and
necessarily by laparoscopy. In case of
complications performed emergency surgery
независимо от срока of pregnancy.

Вопрос: howие могут быть последствия после
operations?

Possible recurrence of pathology, when in the ovary preserved
germinal tissue in its infancy. Not excluded
the occurrence of genital endometriosis, especially when performing
operations in the period of monthly or on the eve of an emergency
(retrograde blood request from the uterine cavity to the pelvis). When
double-sided dermoid can develop infertility.

Вопрос: Обязательно ли оперироваться при наличии
dermoid?

Yes. The exceptions are only small formations (up to 3 cm),
who do not grow and do not cause complaints. But in any case, a woman
should be regularly monitored by a gynecologist and underwent an ultrasound scan. If you
If you are planning a pregnancy, then the dermoid must be removed before conception.
regardless of its size.

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